prep u FUND ch25

There is an 86-year-old female on the medical inpatient unit. She explains that the hospital is quite noisy and that she is having difficulty sleeping. Which is not true regarding sleep in the older adult? a) Deep sleep declines in the older adult. b) Stage 1 sleep increases in the older adult. c) Chronic cardiovascular or respiratory illness can interfere with sleep. d) Sleep medications are usually the first choice in treating sleep disturbance.

d - Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

According to Erikson's theory of development, what do adults who do not achieve the tasks of middle adulthood

they focus on themselves, becoming overly concerned with their own physical and emotional health needs. Emotional detachment, loss of trust, and a focus on new romantic relationships and sexuality are not specified within Erikson's characterization of development in middle adulthood.

The Health Belief Model

used to describe health behaviors

Medications are typically the last choice for treating sleep disturbance because they can interact with other medications or have paradoxical effects on the older adult.

Developmental tasks of the young adult center on establishing intimate relationships, a home, and a family. Becoming independent and separated from parents should have already occurred. They may still be trying out new things, but that is not at the center of the main developmental tasks.

maturation of humans through stages

Developmental theory

infant

1 month to 1 year

toddler

1-3 years

adolescent

12-20 years

young adult

20's and 30's

preschooler

3-6 years

The embryonic stage

4th through the 8th week. Rapid growth and differentiation of the cell layers take place. By the end of this stage, all basic organs have been established, the bones have begun to ossify, and some human features are recognizable. Because this is a period of such rapid growth and change, the fetus is especially vulnerable to any factor that might cause congenital anomalies

school-aged child

6-12 years

fetal stage

9 weeks to birth

First trend occurring with growth and development of the infant

Cephalocaudal (proceeding from head to tail) development is the first trend, with the head and brain developing first, followed by the trunk, legs, and feet.

describes, explains, predicts, and controls outcomes in nursing practice

Nursing theory

Once physiologic needs are met, nurses can concentrate on meeting self-actualization needs of patients. What are examples of self- actualization needs according to Maslow's hierarchy of needs? (Select all that apply.) a) A nurse refers a patient's spouse to an Al- Anon group meeting. b) A nurse subscribes to several nursing journals to stay abreast of developments in the profession. c) A nurse attains a master's degree in nursing by going to school in the evening. d) A nurse raises the side rails on the bed of a patient at risk for falls. e) A nurse administers insulin to a diabetic patient. f) A student nurse takes a course in communication to improve her ability to relate to patients.

Once physiologic needs are met, nurses can concentrate on meeting self-actualization needs of patients. What are examples of self- actualization needs according to Maslow's hierarchy of needs? (Select all that apply.) You selected: • A nurse subscribes to several nursing journals to stay abreast of developments in the profession. • A student nurse takes a course in communication to improve her ability to relate to patients. • A nurse attains a master's degree in nursing by going to school in the evening. Correct Explanation: The highest level on the hierarchy of needs is self- actualization needs, which include the need for individuals to reach their full potential through development of their unique capabilities. A nurse referring a client's spouse to an Al-Anon group meeting would be an example of addressing self-esteem, Level 4. A nurse raising the side rails on the bed of a client at risk for falls would be Level 2, safety and security. A nurse administering insulin to a diabetic client would be Level 1, physiological needs. A nurse going to school to attain a higher degree, or improving one's knowledge would be self-actualization, Level 5, examples.

ectropion

Outward turning of the lower lid is termed

Crepitus

Problems with the temporomandibular joint include pain or a grating feeling

normal lung sounds

Soft, low-pitched, whispering sounds

4 stages of Illness Behaviors

Stage 1 is experiencing symptoms. Stage 2 is assuming the sick role. Stage 3 is assuming a dependent role. Stage 4 is achieving recovery and rehabilitation.

describes how parts interact together

Systems theory

Levels of care:

The first contact with a general physician is the primary care Consultation and diagnostic tests are included in the secondary level of health care. Tertiary care level is a highly specialized facility for desensitization. The secondary and tertiary care facilities are equipped to provide highly specialized care. Extended care is care provided to clients who no longer require acute hospital care.

Second trend occurring with growth and development of the infant

The second trend is proximodistal development, which means that growth progresses from gross motor movements (such as learning to lift one's head) to fine motor movements (such as learning to pick up a toy with the fingers).

Sequence for checking abdomen

The sequence of techniques used to assess the abdomen is inspection, auscultation, percussion, and palpation

Operational stage

With formal the child uses abstract thinking.

What does PICO stand for

Within the PICO question framework, the "O" denotes the outcome of interest. In this case, the desired outcome is the prevention of skin breakdown. Stroke clients are the "P," or population of interest, while turning clients more frequently is the "I," or intervention. The current turning schedule is the "C," referring to the comparison of interest.

The Health-Illness Continuum

a way to measure a person's level of health.

The nurse utilizing the nursing process includes which of the following steps? Select all that apply. a) Implement b) Prescribe c) Assess d) Plan e) Evaluate

a,c,d,e

Stage 4

achieving recovery and rehabilitation

Stage 3

assuming a dependent role

Stage 2

assuming the sick role

The nurse practitioner is discussing health promotion with a group of senior nursing students. What would be the best example of secondary health promotion? a) Workplace health and safety seminar b) Family counseling c) Immunizations d) Weight loss program

b - Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of those found; this includes emotional issues, making family counseling the correct answer. Workplace health and safety would be considered a primary health promotion activity, as would a weight loss clinic and an immunization clinic.

Maslow's theory

based on a pyramid of human needs related to the most primitive needs moving toward higher level needs, such as self-actualization

Developmental theory

based on growth and maturation of humans

Pupils are evaluated by

bilaterally for size, shape, accommodation, and reaction to light.

neonate

birth to 28 days

The acute care nurse is assessing a newly admitted client's abdomen. Which finding would indicate the need to contact the primary care provider? a) Percussion of dull sounds over the right upper quadrant b) Percussion of tympanic sounds over the intestines c) Auscultation of a bruit d) Auscultation of peristalsis sounds

c-A bruit on auscultation suggests an aneurysm or arterial stenosis.

miosis

constriction of the pupil, which is often caused by medications.

Ptosis

drooping of the upper lids and is an abnormal finding.

Quasi-experimental research

examines cause-and-effect relationships between selected variables.

Experimental research

examines cause-and-effect relationships between variables under highly controlled conditions, often in a laboratory setting.

Correlational research .

examines the type and degree of relationships between two or more variables

The pre-embryonic stage

first 3 weeks.

definition of health

health is a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity

describes adjustment of living things to other living things and the environment

Adaptation theory

The nurse is preparing to do a focused assessment of the abdomen on a client following an abdominal hysterectomy. Which intervention is most important for the nurse to do prior to the physical assessment? a) Ask the client to empty her bladder. b) Warm the equipment. c) Measure height and weight. d) Place the client in a semi-Fowler's position.

Before palpating or percussing the abdomen, the client should empty her bladder to avoid discomfort or pressure during the examination. The only equipment used during the assessment of the abdomen is a stethoscope and the nurse's hands. Both can be warmed with the hands at the time of use. The client should be placed in a flat position with the arms at the sides. It is not necessary to obtain height and weight prior to the assessment. (less)

A client has been reporting persistent headaches. Which is an example of subjective data? a) Pain is 4 out of 10 on a pain scale. b) The client appears lethargic. c) The client is alert and oriented to person, place, and time. d) Temperature is 104.1°F (40.05°C)

Communicating the client's pain level is only something the client can state and validate. Subjective data are those symptoms, feelings, perception, preferences, values, and information that only the client can describe. The rest of the options can be directly observed or measured and are known as objective data. (less)

entropion

Inward turning of the lower lid is termed

What stage do newborns belong to

Newborns belong to the sensorimotor stage of cognitive development, characterized by activities such as grasping and displaying basic reflexes. The preoperational stage is characterized by assigning meaning or identity to an object governed by own perceptions. The concrete operational stage is characterized by concrete thinking and using more logic. The formal operational stage emerges around 12 years of age and is characterized by the ability to think abstractly. (less)

Third trend occurring with growth and development of the infant

The last trend is symmetric development of the body, with both sides of the body developing equally.

"What can we do to help you meet any religious needs you may have?"

The nurse should always respect the client's religious beliefs and ask if he has any religious needs that may affect his health care. Comparing the client's beliefs to those of the nurse is inappropriate. Asking general questions about the client's religion would not identify other aspects of his religion that might affect his health care. A too narrow focus on only dietary restrictions or specific medical treatments will not give the nurse enough information to develop an inclusive plan of care.

A nurse is teaching a 7-year old diabetic child who is in Piaget's concrete operational stage about insulin injections. Based on Piaget's theory, what would be the nurse's best method of preparation for this child? a) Explain the procedure to the child in detail. b) Show the child a video about diabetes and insulin. c) Demonstrate the procedure on a teddy bear. d) Give the child a pamphlet on diabetes to read.

c - During this stage, children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. A child in this stage would best learn the procedure by handling the equipment and having it demonstrated on a teddy bear or doll.

The High-Level Wellness Model

characterized by functioning to one's maximum potential while maintaining balance and purposeful direction in the environment.

A nurse is teaching parents of preschoolers about growth and development of their children. Which teaching point would the nurse include? a) Growth and development occur at similar stages and rates for each age group. b) Growth and development do not follow regular predictable trends. c) Aspects of growth and development cannot be modified. d) The pace of growth and development is specific for each person.

d-The pace of growth and development is specific and individualized for each person. Growth and development follow regular predictable trends, as noted by various developmental theorists. Growth and development do not occur at similar stages and rates for each age group. Aspects of growth and development can be modified. (less)

Stage 1

experiencing symptoms

The five major areas of family function are :

physical, economic, reproductive, affective and coping, and socialization.

Nursing research expands knowledge to learn improved ways to ________ and _________ health.

promote and maintain

As defined by the World Health Organization, one's health includes

social, and mental components and is not merely the absence of disease or infirmity

Systems theory

studying relationships between a whole and identifying how parts interact and behave

You are teaching a "Young Childcare" class and Bill, one of the parents, asks what kinds of new physical skills his 13-month-old son will be learning during the next 2 years. Which of the following responses would be appropriate? Choose all that apply. a) Runs, kicks, climbs stairs b) Drinks from a cup c) Uses a spoon d) Walks forward and backward e) Skips, and catches a ball

• Drinks from a cup • Runs, kicks, climbs stairs • Uses a spoon • Walks forward and backward Explanation: The toddler learns to drink from a cup and use a spoon. The toddler is also able to walk forward and backward; he or she is able to run, kick, and climb stairs. The abilities to skip and catch a ball do not usually occur until preschool age.

Piaget's Sensorimotor stage

A child who picks up a rattler to shake shows the child relating his or her own behavior to the environment.

neonates:

The neonate is assessed immediately after birth at one and five minutes using the Apgar scale. The neonatal period lasts from birth to 28 days. The physical characteristics and behaviors of normal neonates include active reflexes (Moro, stepping, and grasp), hand-to-mouth activity, sucking, swallowing, blinking, sneezing, and yawning. Stool and urine are eliminated. Senses are used to respond to the environment, see color and form, hear and turn toward sound, smell and taste, and feel touch and pain. (less)

Which of the following nursing activities is the most significant in assisting with transitioning from the adolescent to the young adult age group? a) Promoting safe sexual activities for both sexes b) Encouraging safety when participating in sports c) Facilitating healthy family relationships d) Teaching information on chronic illnesses

c-Information exchange through the use of open communication and mutual respect leads to a healthy transition from adolescence to young adulthood. Chronic illness may increase feelings of isolation and disrupt normal development. Practicing safe sexual activities may prevent sexually transmitted diseases. Use of safety during sports activities may prevent injuries. (less)

Cognitive development theory states that human nature is essentially rational and that the individual's basic goal is to learn to master the environment. Which of the following cognitive processes involve the rearranging and structuring of one's knowledge and thoughts? a) Adaptation b) Accommodation c) Organization d) Assimilation

c-The rearranging and structuring of one's knowledge and thoughts is called organization. Assimilation is the ongoing process of organizing new information into existing knowledge. Adaptation is the process of assimilating and accommodating new information. Accommodation is the process of resolving the disequilibrium resulting from the modifications needed in thought processes to incorporate new data. (less)

A nurse refers an HIV-positive client to a local support group. This is an example of what level of preventive care? a) Primary b) Chronic c) Secondary d) Tertiary

d - Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate clients to a maximum level of functioning. Referring an HIV-positive client to a local support group would be an example of tertiary preventive care. Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Secondary health promotion and illness prevention focus on screening for early detection of disease, with prompt diagnosis and treatment of any found. The term chronic is not related to health promotion. (less)

The nurse is caring for an 88-year-old male admitted 2 days ago for dehydration. The nurse brings the client his breakfast tray and notes that the client appears to be having difficulty understanding what she is saying to him today. Which nursing action is most appropriate? a) Speak to the elderly client in a high-frequency tone of voice. b) Check the client's ear canals for cerumen. c) Ask the client if he left his earplugs in his ears. d) Use facial expressions and sign language to communicate.

d- Ear wax (cerumen) becomes drier in the elderly and can block the ear canal and cause decreased hearing. Asking the client if he has earplugs in his ears is not appropriate. Using facial expressions and sign language is appropriate in communicating with the hard of hearing, but this client's hearing loss was acute and requires further assessment. When speaking to the elderly who are hearing-impaired, one needs to use low tones to facilitate communication; high-frequency tones are problematic for the elderly. (less)

The Agent-Host-Environment is useful for

examining the cause of disease in an individual. The agent, host, and environment interact in ways that create risk factors.

Descriptive research

explores and describes events in real-life situations.

Characteristics of ADHD are:

impulsive behaviors, inattention, and hyperactivity, including getting into fights, being easily distracted, and not sitting still. Reversing letters and words and speech impediments are learning disabilities. (less)

Concrete Operational stage

the child can manipulate objects.

Preoperational stage

the child uses symbols and pictures to represent themselves

Friedman and associates identified the importance of family-centered nursing care, based on what four rationales

Friedman and associates identified the importance of family-centered nursing care, based on four rationales. First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become part of the illness. Second, a strong relationship exists between the family and the health status of its members; therefore, the role of the family is essential in every level of nursing care. The third rationale is that the level of health of the family and, in turn, each member can be significantly improved through health-promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members; through assessment and intervention, the nurse can assist in improving the health status of all members. (less)

You are teaching a "care of the newborn" class and Jan, one of the members, asks a question about how newborns tolerate pain. Her baby is a male and she is concerned about how the circumcision will be done. Kate, another member, says that newborns do not feel pain, so not to worry. Which of the following is your best response? a) Neonates feel touch and pain. b) Kate is correct, so no worries. c) Anesthetic is not given for circumcisions. d) They feel pain but forget it instantly.

a - Neonates use senses to respond to the environment, they see color and form, hear and turn toward sound, smell and taste, and feel touch and pain. Anesthesia is usually given with circumcisions. It is not known how long a newborn will remember felt pain.

A nurse is assessing children using Kohlberg's theory of moral development. What are examples of milestones achieved in the preconventional level of this theory? (Select all that apply.) a) The child identifies with family members and conforms to their expectations. b) The child develops a perception of goodness or badness. c) The child learns to follow parent's rules. d) The child develops moral judgment that is rational and internalized into self. e) The child is motivated by punishment for not conforming to rules. f) The child strives for approval in an attempt to be viewed as "good."

b,c,e, - In Kohlberg's preconventional level the child learns to follow parent's rules, is motivated by punishment for not conforming to rules, and develops a perception of goodness or badness. The conventional stage would be represented by the child identifying with family members and conforming to their expectations. The conventional stage would also be represented by the child striving for approval in an attempt to be viewed as "good". The postconventional stage is represented by the child developing moral judgment that is rational and internalized into self.

Which of the following statements explains how pregnancy affects the growth and development of the adolescent? a) Interferes with ability to care for newborn due to loss of innocence b) Affects the normal physical and maturation processes c) Inhibits further education due to caring for infant d) Causes damage to self-identity requiring psychological counseling

b- Pregnancy affects the normal physical and maturation processes of the adolescent. Psychological counseling is not indicated unless the adolescent shows a need for counseling. Loss of innocence does not interfere with the ability to care for an infant. The adolescent can continue education while caring for an infant.

Adaptation theory

based on an understanding of humans and their interaction with the environment

Parents raising two school-aged children incorporate their religious beliefs into the family's daily life. The family's beliefs regarding religion include dietary considerations, worship practices, attitudes, and values. This is an example of which function of the family? a) Affective and coping b) Physical c) Socialization d) Reproductive

c

When a nurse is working on a pediatric unit, which of the following clients would the nurse know has the greatest need for good nutrition? a) 10 year old b) 15 year-old c) 5 month old d) 3 year old

c - An infant rapidly grows and develops within the first year. Good nutrition is needed for adequate growth to prevent failure to thrive. Toddlers, school-age children, and adolescents continue to grow and develop but not as rapidly as infants do.